BNF for Children 2011-2012

278 5.1.4 Aminoglycosides BNFC 2011–20125 InfectionsPregnancy There is a risk of auditory or vestibularnerve damage when aminoglycosides are used in thesecond and third trimesters of pregnancy. The risk isgreatest with streptomycin (section 5.1.9). The risk isprobably very small with gentamicin and tobramycin,but their use should be avoided unless essential (if given,serum-aminoglycoside concentration monitoring isessential).GENTAMICINCautions neonates, infants (adjust dose and monitorrenal, auditory and vestibular function together withserum gentamicin concentrations); avoid prolongeduse; conditions characterised by muscular weakness;see also notes above; interactions: Appendix 1(aminoglycosides)Contra-indications myasthenia gravisRenal impairment see notes abovePregnancy see notes aboveSide-effects vestibular and auditory damage,nephrotoxicity; rarely, hypomagnesaemia on prolongedtherapy, antibiotic-associated colitis; alsoreported, nausea, vomiting, rash, blood disorders; seealso notes aboveLicensed use not licensed for nebulisationPharmacokinetics Extended interval dose regimenin neonates: pre-dose (‘trough’) concentrationshould be less than 2 mg/litreOnce daily dose regimen: pre-dose (‘trough’) concentrationshould be less than 1 mg/litreMultiple daily dose regimen: one hour (‘peak’)serum concentration should be 5–10 mg/litre (3–5 mg/litre for endocarditis, 8–12 mg/litre in cysticfibrosis); pre-dose (‘trough’) concentration shouldbe less than 2 mg/litre (less than 1 mg/litre forendocarditis)Intrathecal/intraventricular injection: cerebrospinalfluid concentration should not exceed 10 mg/litreIndication and doseTo avoid excessive dosage in obese children, use idealweight for height to calculate parenteral dose andmonitor serum-gentamicin concentration closelySepticaemia, meningitis and other CNS infections,biliary-tract infection, acute pyelonephritis,endocarditis (see notes above), pneumoniain hospital patients, adjunct in listerialmeningitis (Table 1, section 5.1). Once daily dose regimen (not for endocarditisor meningitis) by intravenous infusionChild 1 month–18 years initially 7 mg/kg, thenadjusted according to serum-gentamicin concentration. Multiple daily dose regimen by intramuscularor by slow intravenous injection over at least 3minutesChild 1 month–12 years 2.5 mg/kg every 8 hoursChild 12–18 years 2 mg/kg every 8 hoursPseudomonal lung infection in cystic fibrosis. Multiple daily dose regimen by slow intravenousinjection over at least 3 minutes or byintravenous infusionChild 1 month–18 years 3 mg/kg every 8 hoursBacterial ventriculitis and CNS infection (supplementto systemic therapy). By intrathecal or intraventricular injection,seek specialist adviceNeonate seek specialist adviceChild 1 month–18 years 1 mg daily (increased ifnecessary to 5 mg daily)Note only preservative-free, intrathecal preparationshould be usedEye section 11.3.1Ear section 12.1.1Note Local guidelines may varyAdministration for intravenous infusion, dilute inGlucose 5% or Sodium Chloride 0.9%; give over 30minutesFor nebulisation, dilute preservative-free preparationin 3 mL sodium chloride 0.9%. Administer after physiotherapyand bronchodilatorsFor intrathecal or intraventricular injection, use preservative-freeintrathecal preparations onlyNeonatal sepsis. Extended interval dose regimen by slow intravenousinjection or intravenous infusionNeonate less than 32 weeks postmenstrual age4–5 mg/kg every 36 hoursNeonate 32 weeks and over postmenstrual age4–5 mg/kg every 24 hours. Multiple daily dose regimen by slow intravenousinjectionNeonate less than 29 weeks postmenstrual age2.5 mg/kg every 24 hoursNeonate 29–35 weeks postmenstrual age2.5 mg/kg every 18 hoursNeonate over 35 weeks postmenstrual age2.5 mg/kg every 12 hoursGentamicin (Non-proprietary) AInjection, gentamicin (as sulphate), net price 40 mg/mL, 1-mL amp = £1.40, 2-mL amp = £1.54, 2-mL vial= £1.48Paediatric injection, gentamicin (as sulphate) 10 mg/mL, net price 2-mL vial = £1.80Intrathecal injection, gentamicin (as sulphate) 5 mg/mL, net price 1-mL amp = 74pIntravenous infusion, gentamicin (as sulphate) 1 mg/mL in sodium chloride intravenous infusion 0.9%, netprice 80-mL (80 mg) bottle = £1.95; 3 mg/mL, 80-mL(240 mg) bottle = £5.95, 120-mL (360 mg) bottle =£8.45Cidomycin c (Sanofi-Aventis) AInjection, gentamicin (as sulphate) 40 mg/mL. Netprice 2-mL amp or vial = £1.48